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김태훈; 조민정; 박정준; 김대연; 김성철; 김인구

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자료유형: 학술저널

저자정보: 김태훈 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아외과) 조민정 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아외과) 박정준 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아흉부외과) 김대연 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아외과) 김성철 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아외과) 김인구 (울산대학교 의과대학 서울아산병원 소아청소년병원 소아외과)

저널정보: 대한소아외과학회 Journal of the Korean Association of Pediatric Surgeons : JKAPS Journal of the Korean Association of Pediatric Surgeons : JKAPS 제17권 제2호

발행연도: 2011.1

수록면: 133 - 138 (6page)

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Extracorporeal membrane oxygenation (ECMO) has been utilized in congenital diaphragmatic hernia (CDH) patients with severe respiratory failure unresponsive to conventional medical treatment. We retrospectively reviewed 12 CDH patients who were treated using ECMO in our center between April 2008 and February 2011. The pre ECMO and on ECMO variables analyzed included gestational age, sex, birth weight, age at the time of ECMO cannulation, arterial blood gas analysis results, CDH location, timing of CDH repair operation, complications and survival. There were 9 boys and 3 girls. All patients were prenatally diagnosed. Mean gestational age was $38.8{\pm}1.7$ weeks and mean birth weight was $3031{\pm}499$ gram. Mean age at the time of ECMO cannulation was $29.9{\pm}28.9$ hours. There were 4 patients who survived. Survivors showed higher 5 min Apgar scores ($8.25{\pm}0.96$ vs. $7.00{\pm}1.20$, p=0.109), higher pre ECMO mean pH ($7.258 {\pm}0.830$ vs. $7.159{\pm}0.986$, p=0.073) and lower pre ECMO $PaCO_2$ ($48.2{\pm}7.9$ vs. $64.8{\pm}16.1$, p=0.109) without statistical significance. The hernia was located on the left side in 10 patients and the right side in 2 patients. The time interval from ECMO placement to operative repair was about 3~4 days in 5 early cases and around 24 in the remaining cases. There were 3 cases of post operative bleeding requiring re operation and 2 cases of abdominal compartment syndrome requiring abdominal fascia reopening. ECMO catheter reposition was required in 4 cases. Three cases of arterial or venous thrombosis were detected and improved with follow up. Our data suggests that ECMO therapy could save the lives of some neonates with CDH who can not be maintained on other treatment modalities. Protocolized management and accumulation of case experience might be valuable in improving outcomes for neonates with CDH treated with ECMO.

#Extracorporeal membrane oxygenation #Congenital diaphragmatic hernia

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